Epaillard Nicolas, Benitez Jose Carlos, Gorria Teresa, Fabre Elizabeth, Riudavets Mariona, Reyes Roxana, Planchard David, Oudard Stéphane, Viñolas Nuria, Reguart Noemi, Besse Benjamin, Mezquita Laura, Auclin Edouard
Medical and Thoracic Oncology Department, Hôpital Européen Georges Pompidou AP-HP, Université de Paris, France.
Medical Oncology Department, Institut Gustave Roussy, Villejuif, France.
Lung Cancer. 2021 May;155:114-119. doi: 10.1016/j.lungcan.2021.03.015. Epub 2021 Mar 24.
Pleural effusion (PE) is a common metastatic site of NSCLC, associated with poor outcomes. As very few data are available about immune checkpoint inhibitors (ICI) and PE, we aimed to assess the clinical outcome of PE in NSCLC treated with ICI.
Multicenter international retrospective study of patients with metastatic NSCLC treated with ICI, between 2012 and 2019. Stratification according to the presence of PE at ICI baseline or appearance under ICI treatment (PE group) versus no history of PE (non-PE group). Primary endpoints were overall survival (OS) and early death rate (EDR, OS ≤ 3 months).
A total of 538 patients were included: 196 in the PE group and 342 in the non-PE group. In the PE group, median age was 64, 31.6 % were female, 77.6 % had non-squamous histology, PD-L1 was ≥50 % in 38.6 % of cases (95 missing). PE was more likely associated with >2 metastatic sites (70.4 % vs. 50 %) and worse performance status (PS ≥ 2, 30.8 % vs 23.1 %). Globally, the overall median OS was 9.7 months [95 %CI: 8.1-11.8]; 6.3 [95 % CI: 4.0-8.6] in PE vs. 11.4 [95 %CI: 9.7-13.8] in the non-PE respectively, P = 0.002. Overall the EDR was 31.4 %; higher in the PE group (38.3 % vs. 27.5 %; OR 1.63, 95 %CI: 1.13-2.37, P = 0.01). In the PE PD-L1≥50 % group, EDR was 33.3 %. In multivariate analysis, after adjustment on PS, liver/intracranial/bone metastasis, ICI line and dNLR, PE remained an independent prognostic factor for OS [HR: 1.38, 95 %CI: 1.09-1.74, P = 0.007]. In the PE group, PE appeared under ICI for 31 patients (16.4 %). We observed lower EDR in this group compared to patients whom PE was already present (29.0 % vs 40.5 %, P = 0.2).
PE is associated with worse immunotherapy outcomes in NSCLC treated with ICI, including in patients with ≥50 % PD-L1 tumors. Thus, in these patients, combination strategies should be explored.
胸腔积液（PE）是NSCLC常见的转移部位，与不良预后相关。由于关于免疫检查点抑制剂（ICI）和PE的数据非常有限，我们旨在评估接受ICI治疗的NSCLC患者中PE的临床结局。
对2012年至2019年间接受ICI治疗的转移性NSCLC患者进行多中心国际回顾性研究。根据ICI基线时是否存在PE或ICI治疗期间是否出现PE进行分层（PE组）与无PE病史（非PE组）。主要终点是总生存期（OS）和早期死亡率（EDR，OS≤3个月）。
共纳入538例患者：PE组196例，非PE组342例。PE组中位年龄为64岁，女性占31.6%，77.6%为非鳞状组织学类型，38.6%的病例（95例缺失）PD-L1≥50%。PE更可能与>2个转移部位相关（70.4%对50%）和更差的体能状态（PS≥2，30.8%对23.1%）。总体而言，总中位OS为9.7个月[95%CI：8.1-11.8]；PE组为6.3[95%CI：4.0-8.6]，非PE组为11.4[95%CI：9.7-13.8]，P=0.002。总体EDR为31.4%；PE组更高（38.3%对27.5%；OR 1.63，95%CI：1.13-2.37，P=0.01）。在PE组中，PD-L1≥50%的患者中EDR为33.3%。在多变量分析中，在对PS、肝/颅内/骨转移、ICI线和dNLR进行调整后，PE仍然是OS的独立预后因素[HR：1.38，95%CI：1.09-1.74，P=0.007]。在PE组中，31例患者（16.4%）在ICI治疗期间出现PE。与PE已存在的患者相比，我们观察到该组的EDR较低（29.0%对40.5%，P=0.2）。
在接受ICI治疗的NSCLC患者中，PE与较差的免疫治疗结局相关，包括PD-L1肿瘤≥50%的患者。因此，对于这些患者，应探索联合治疗策略。
